Laparoscopic side-to-side esophagogastrostomy using a linear stapler after proximal gastrectomy

Abstract

trectomies in two patients with gastric cancer. Here, we describe our surgical procedure and the postoperative courses of these two patients. Surgical procedureEach patient was placed under general anesthesia in the supine, reverse Trendelenburg position with the legs apart. The surgeon stood on the patient's right, with the assisting surgeon on the patient's left, and the camera operator stood between the patient's legs. Pneumoperitoneum was then established, using an open technique, and five working ports (each 12 mm in diameter) were then placed.Laparoscopic mobilization and transection of the stomach, and lymphadenectomy (which consisted of a limited dissection A according to the new Japanese practice guidelines for gastric cancer) were performed by the same methods as those that we reported previously ( Fig. 1) [8]. In our procedure, in order to prevent pyloric stenosis, postoperative diarrhea, and an increased risk of cholelithiasis, the vagal pyloric, celiac, and hepatic branches were preserved. Accordingly, the esophagus was not transected until after anastomosis, to allow the esophagogastrostomy to be performed safely. Side-to-side esophagogastrostomyThis anastomosis involves attaching the posterior aspect of the esophagus to the anterior wall of the gastric remnant. There must be sufficient overlap so that 5-6 cm of esophagus will lie freely over the front of the gastric remnant. Therefore, the esophagus was sufficiently mobilized to allow this. The posterior wall of the esophagus was excised, and a 1-cm stab wound was made in the anterior wall of the gastric remnant, approximately 5-6 cm from the staple lines of the stump. A 45-mm endoscopic linear stapler (ETS45; Ethicon Endo-Surgery, AbstractIn order to improve anastomotic procedures, we performed laparoscopic side-to-side esophagogastrostomy, using a linear stapler, after proximal gastrectomy in two patients with gastric cancer located in the upper third of the stomach. The patients' postoperative courses were excellent. During postoperative recovery, the patients experienced very little pain, used no analgesic medications, and never experienced reflux esophagitis. This procedure is technically feasible and is an excellent option, given the less involved anastomotic procedure and better postoperative quality of life compared with these features in end-to-side anastomosis using a circular stapler.

New double-stapling technique for esophagojejunostomy and esophagogastrostomy in gastric cancer surgery, using a peroral intraluminal approach with a digital stapling system

“…Recently, as well as the conventional circular stapler method, functional end-to-end anastomosis or overlap anastomosis, performed with a linear stapler, has been used for esophagojejunostomy in LATG and for esophagogastrostomy in laparoscopy-assisted proximal gastrectomy (LAPG) [10,11]. However, with the linear stapler, a greater extent of dissection and longer exposure of the abdominal esophagus are required than with the usual circular stapler method.…”

A systematic review of laparoscopic total gastrectomy for gastric cancer

“…Two types of esophagojejunostomy have been reported using linear staplers, a functional end-to-end anastomosis [35][36][37][38] and a side-to-side anastomosis (or the overlap method) [39][40][41][42][43]. The functional end-to-end procedure is performed by inserting the linear stapler into the esophagus thorough a small hole on the left side of the esophageal stump and simultaneously lifting the jejunum to insert the stapler through a small hole on the opposite side of the jejunum mesenterium.…”

Laparoscopic gastrectomy after incomplete endoscopic resection for early gastric cancer

“…Laparoscopic total gastrectomy (LTG) was performed for tumors in the upper third of the stomach by adapting LPG. After LPG and LTG, esophagogastrostomy and esophagojejunostomy were performed, respectively, using a linear stapler (ETS45; Ethicon, blue cartridge) as previously described with some modifications (13,14). LAG was performed by a surgeon who had previously performed more than 50 LAGs.…”